Provider Demographics
NPI:1063423036
Name:DEMPSEY, KAROLINE CASEY (PAC)
Entity type:Individual
Prefix:MS
First Name:KAROLINE
Middle Name:CASEY
Last Name:DEMPSEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12469 EMERALD COAST PKWY W
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-8305
Mailing Address - Country:US
Mailing Address - Phone:850-654-3376
Mailing Address - Fax:850-654-3320
Practice Address - Street 1:12469 EMERALD COAST PKWY W
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550
Practice Address - Country:US
Practice Address - Phone:850-654-3376
Practice Address - Fax:850-654-3320
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104546363A00000X
NVPA1548363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010153205OtherREGENCE BS MTN HOME
ID807305800Medicaid
IDPAZR3OtherBLUE CROSS
ID0000101532303OtherREGENCE BS BOISE
ID000010153985OtherREGENCE EMMETT
NVV108320Medicare PIN
ID000010153985OtherREGENCE EMMETT